Small artery remodelling in hypertension

Increased blood pressure (essential hypertension) is associated with increased cardiovascular risk, and the condition is treated primarily with a view to reducing this parameter. However, in the early stages, the main pathological changes are increased peripheral resistance and altered cardiovascular structure. The aim of this MiniReview was to trace the endeavours over the past several decades to translate these findings into answering the question whether normalization of resistance vessel structure should be a target for therapy. This MiniReview describes first the altered structure of the resistance vasculature in essential hypertension, where the vessels show increased media/lumen ratio because of inward eutrophic remodelling. Secondly, evidence is presented that altered small artery structure appears to have prognostic consequences. Then, the cellular mechanisms that may be involved are discussed, where there is evidence that vasoconstriction in itself can cause inward remodelling and that this can be prevented by vasodilators. This leads to a discussion of the degree to which it may be possible to rectify the abnormal structure, where it appears that this may be achieved using a therapy that causes vasodilatation in the patient concerned. Finally, the consequences of these findings are considered as regards clues for strategies that may be able to improve the outcome of antihypertensive therapy. The MiniReview concludes that there is reasonably strong evidence that improvement in abnormal resistance vessel structure requires a treatment that reduces peripheral resistance in the individual patient.